The efficacy of combining fractional CO2 laser and tacrolimus ointment in the treatment of vitiligo

Abstract

Background Treatment of vitiligo is very challenging. Topical tacrolimus is one of the topical modalities reported to be successful. No single treatment, however, gives on its own satisfactory results, and combination treatments offer better outcomes. Fractional CO2 laser (FCO2) has been recently studied as an adjuvant treatment with other modalities in vitiligo. Objective To evaluate the value of adding FCO2 laser before tacrolimus ointment in vitiligo. Patients and methods This is a randomized controlled prospective clinical trial including 27 patients with stable vitiligo with a total of 152 lesions. Lesions on one side of the body received one session of FCO2 every month for 3 months in addition to tacrolimus ointment twice daily for 3 months, whereas lesions on the other side of the body received tacrolimus ointment only. Results Lesions treated with the combination modality showed improvement in 17 (22.36%) lesions, with a mean reduction in Vitiligo Area Scoring Index (VASI) of 10.05%, whereas lesions treated with tacrolimus only showed improvement in 13 (17.1%) lesions, with a mean reduction in VASI of 5.535%, yet these differences were not statistically significant (P=0.46 and 0.24, respectively). Acral lesions showed significantly more reduction in VASI when treated with combination therapy than with tacrolimus only (P=0.034). Lesions with shorter duration showed significant more reduction in VASI scores when treated with the combination (P=0.024). Conclusion Treatment of stable vitiligo with FCO2 before tacrolimus yields mild improvement, statistically not significantly better than tacrolimus only except in acral areas. Lesions of shorter duration show significantly better response to the combination treatment than to tacrolimus only.